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The study found that 20 percent of antibiotics are prescribed without an in-person meeting with a healthcare provider.

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October 8, 2018

A sweeping survey shows almost one-half of all antibiotics are prescribed to patients who don’t have an infection-related diagnosis, and 1 in 5 prescriptions were issued without an in-person office visit.

The study, the first to look at overall outpatient antibiotic prescribing, comes after many years of efforts by public health authorities to curb inappropriate antibiotic prescribing practices, such as prescribing them for cold symptoms. Overuse of antibiotics can cause bacteria to mutate and become resistant to medication designed to kill them, called antibiotic resistance.

“We’re been pretty cavalier about the use of antibiotics,” says Jeffrey A. Linder, MD, MPH, lead author of the study and chief of the division of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine in Chicago.

How the Study Was Conducted

Dr. Linder and his colleagues analyzed more than one-half million prescriptions from 514 outpatient clinics given to 279,169 patients from November 2015 through October 2017. The records encompassed 2,413 clinicians, including medical doctors, nurse practitioners, and physician assistants in a range of primary care and specialty settings.

The analysis found that 46 percent of antibiotics were prescribed without an infection-related diagnosis — 29 percent noted something other than an infection diagnosis (such as high blood pressure or annual visit) and 17 percent were written without a diagnosis indicated. Some of the apparent inappropriate prescribing may be the result of sloppy diagnosis coding, according to Linder. But much of it reflects antibiotic prescribing for vague or inappropriate reasons, such as infections that are caused by viruses.

“For the average person, you should almost never get an antibiotic without being seen for symptoms like colds, flu, sore throat or coughs,” Linder says, adding that doctors should evaluate patients in person to check for signs of more serious conditions, such as pneumonia or strep throat.

“Antibiotics themselves are not benign,” Linder says. “You can have an allergic reaction to an antibiotic. Antibiotics can interact with other drugs. Antibiotics can cause diarrhea and occasionally an infection called C. difficile. If you’re taking antibiotics for cold and flu symptoms, you’re taking a medication that has no chance of helping you and has a real chance of hurting you.”

As virtual healthcare visits become more popular, the finding that 20 percent of antibiotics are prescribed without an in-person meeting with a healthcare provider raises fresh concerns. Researchers plan to analyze that data to determine what portion of those prescriptions may have been inappropriate.

Therapy Dogs and Infection Risk

In other news from the meeting, a new study presented October 4, 2018, at IDWeek 2018, found that an easy cleaning procedure can ensure that therapy dogs used to help pediatric patients deal with the stress of hospitalization won’t spread dangerous bacteria to the children.

Researchers at Johns Hopkins Bloomberg Children’s Hospital in Baltimore devised a simple protocol that involved shampooing the therapy dogs with antibacterial chlorhexidine before the first visit of the day and using chlorhexidine wipes every 5 to 10 minutes during visits. The process dramatically reduces the likelihood that the dogs will spread methicillin-resistant Staphylococcus aureus (MRSA).

“We have limited therapy dogs with our oncology patients because of concerns about transmission of infections,” said Chris Nyquist, MD, a professor of pediatric infectious diseases at the University of Colorado in Aurora, who was not involved in the study, in a news conference. “This study allows a wonderful opportunity to expand the use of therapy dogs.”

The study of 45 patients found 15.4 percent became MRSA carriers before the cleansing protocol was implemented, compared with 4.5 percent after implementation. Researchers also found that patients who interacted closely with the dogs, such as by petting or hugging them before the cleansing protocol, were 6 times more likely to become MRSA carriers than patients who didn’t interact closely. But once the dogs were decolonized, the risk for becoming MRSA carriers was no different in the close interaction group.

The study also confirmed previous research that hospitalized children benefit by interaction with pets, said the study author, Kathryn Dalton, VMD, a PhD candidate in the department of environmental health and engineering at Johns Hopkins Bloomberg School of Public Health in Baltimore. “We saw decreased stress levels, decreased reports of anxiety, and decreased reports of pain. These positive benefits were not diminished by the use of this intervention.”

The rates were linked to a higher-than-normal number of people with the predominant influenza A strain (H1N1). That strain contributed to more than 25 percent of flu cases across most age groups, compared with fewer than 10 percent of A strain infections in prior years.

The analysis showed higher overall rates of H3N2 and B virus infection compared with prior years and that different strains were more common in various age groups. H1N1 was more common in people under age 65 compared with those 65 and older.

Shigella causes about 500,000 illnesses annually in the United States. Antibiotics are prescribed for people with weakened immune systems to shorten the duration of the illness and limit its spread. Other antibiotics, such as ciprofloxacin, are also becoming less effective in treating shigella due to drug-resistant organisms.

IDWeek 2018 is the annual meeting of IDSA, the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS).